| NPI | 1952867095 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIFFANY MADDOX In Office Dispensary Manager 919-390-3978 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site |
| Enumeration Date | 2019-02-13 |
| Last Update Date | 2020-11-13 |